Tissue clamp and implantation method

Abstract

A surgical clamp for aligning the margins of incised or wounded tissue has jaws with parallel clamping faces, and a handle for manipulating the clamp to align the margins of the tissue. The jaws are in a normally closed position, however they can be opened by compressing the handle to open the jaws. Prongs project from the inferior surface of the jaws. The clamp is positioned in a desired position over the margins of a wound to be closed, the prongs engage the margins of the wound to be aligned, and the jaws are closed by releasing compressive force on the handle. As the jaws close the prongs help move the tissue into alignment. Suture guide slots through the jaws assist in the placement of precisely placed sutures across the incision. The disclosed surgical clamp is particularly suited for selectively closing and reopening surgical incisions, such as a sclerotomy incision in the eye. Methods are disclosed for using the clamp during intraocular and other surgical or minimally invasive procedures. In one example the clamp is used during implantation into the retina of a scaffold on which choroid and retinal pigment epithelium cells and retina grow in a three-dimensional matrix that mimics the native structure of the retina.

We claim: 
     
         1 . A surgical instrument for clamping a target structure, comprising:
 a clamp having a first jaw forming a first clamping surface, and a second jaw forming a second clamping surface that opposes the first clamping surface; and   a handle connecting the first and second jaws wherein the handle comprises an arm portion and a leg portion, wherein the arm portion comprises first and second substantially parallel arms that are respectively connected to the first jaw and the second jaw, and the leg portion comprises first and second legs that join at a common apex of the leg portion with a resilient bias that resiliently biases the first clamping surface and second clamping surface against each other into a substantially closed relationship for clamping the target structure, the first and second legs being disposed in a plane that extends at an angle to the first and second jaws of the clamp;   wherein the handle is compressibly movable to overcome the resilient bias and open the clamp by moving the first jaw and/or the second jaw to an open position while maintaining the first clamping surface and the second clamping surface in a substantially aligned orientation relative to one another, compression of the first and second legs of the handle toward each other moving the first and second arms against the resilient bias to open the jaws;   wherein the clamp has an inferior surface forming respective inferior surfaces of each jaw for resting on tissue to be clamped, and an opposing superior surface for facing upwardly away from the tissue to be clamped, wherein the clamp further comprises compression prongs that extend downwardly from the inferior surface of each jaw for extending toward an incision to be closed.   
     
     
         2 . The surgical instrument of  claim 1 , wherein the handle comprises an intermediate portion between the arm portion and the leg portion, wherein the intermediate portion crosses over itself whereby compression of the leg portion to move the first and second legs toward one another overcomes the resilient bias to move the first and second arms away from one another, thereby moving the first and second jaws of the clamp away from one another. 
     
     
         3 . The surgical instrument of  claim 1 , wherein the handle is a single continuous length of resiliently biased material configured to open the jaws in response to a compressive force applied to the handle. 
     
     
         4 . The surgical instrument of  claim 3 , wherein the handle comprises a continuous metal or alloy wire connector that forms the arm portions and the leg portions of the handle, wherein first and second legs are non-parallel. 
     
     
         5 . The surgical instrument of  claim 3 , wherein the wire connector comprises an alignment guide formed by at least one of a bent portion of an intermediate portion of the wire connector, and a bend in the first leg of the wire connector that forms an elongated alignment channel through which the second leg extends to maintain the aligned orientation of the first and second clamping surfaces. 
     
     
         6 . The surgical instrument of  claim 1 , wherein the first and second clamping surfaces are arcuate. 
     
     
         7 . The surgical instrument of  claim 1 , wherein the first clamping surface and the second clamping surface form an aperture therebetween when disposed adjacent one another, the aperture extending from the superior surface to the inferior surface. 
     
     
         8 . The surgical instrument of  claim 1 , wherein the inferior surface is curved to conform to the shape of an anatomic structure to be clamped. 
     
     
         9 . A method of closing a wound with the instrument of  claim 1 , comprising:
 moving the handle to overcome the resilient bias and open the clamp;   placing the clamp on the wound with margins of the wound between clamping surfaces of the first and second jaws;   closing the jaws of the clamp with the margins of the wound retained between the clamping surfaces.   
     
     
         10 . The method of  claim 9 , wherein the instrument comprises a guide slot extending transversely through the first and second jaws to define a needle trajectory, and the method further comprises introducing a curved needle in the needle trajectory and placing a suture across the margins of the wound along the needle trajectory. 
     
     
         11 . The method of  claim 9 , wherein the compression prongs comprise barbs, and the method further comprises inserting the barbs into the skin as the jaws of the clamp close with the margins of the wound retained between the clamping surfaces. 
     
     
         12 . The method of  claim 9 , wherein the wound is a surgical incision. 
     
     
         13 . The method of  claim 12 , wherein the surgical incision is opened and closed multiple times during a surgical procedure by removing and reapplying the clamp to the incision. 
     
     
         14 . The method of  claim 12 , wherein the surgical incision is a sclerotomy incision in an eye, and choroid underlying the sclerotomy incision is pre-treated with a laser to cauterize blood vessels in the choroid underlying the sclerotomy incision prior to making the sclerotomy incision. 
     
     
         15 . The method of  claim 12 , wherein the surgical incision is a sclerotomy incision in an eye of a recipient, and retinal tissue or artificial retina is transplanted into the retina of the eye of the recipient, further comprising;
 immunosuppressing the recipient of the retinal tissue or artificial retina following the procedure to minimize rejection of the transplanted retinal tissue or artificial retina.   
     
     
         16 . A surgical instrument for clamping a target structure, comprising:
 a clamp having a first jaw forming a first clamping surface, and a second jaw forming a second clamping surface that opposes the first clamping surface, the clamping surfaces including an inferior surface of the clamp cooperatively formed by the first and second jaws for resting on tissue to be clamped;   a handle connecting the first and second jaws wherein the handle has a resilient bias that resiliently biases the first clamping surface and second clamping surface against each other into a substantially closed relationship for clamping the target structure;   wherein the handle is movable to overcome the resilient bias and open the clamp by moving the first jaw and/or the second jaw to an open position while maintaining the first clamping surface and the second clamping surface in a substantially aligned orientation relative to one another; and   a suture guide slot that extends through the first and second jaws to define a needle trajectory for placing a suture across an incision that is closed by the clamp, a clamp thickness tapering toward the clamping surfaces and the suture guide slot to minimize clamp thickness along the needle trajectory, the suture guide slot being an elongated opening that extends transversely through the first and second jaws a predetermined distance that corresponds to entrance and exit points of the suture placed across the incision.   
     
     
         17 . The surgical instrument of  claim 16 , wherein the guide slot comprises a bevel at its ends to guide a needle along the needle trajectory. 
     
     
         18 . The surgical instrument of  claim 16 , wherein the superior surface is arcuate and tapers symmetric with respect to the opposing clamping surfaces, and the suture guide slot extends substantially perpendicularly to the opposing clamping surfaces. 
     
     
         19 . The surgical instrument of  claim 16 , wherein the clamp further comprises compression prongs that extend downwardly from the inferior surface of each jaw and are configured to extend toward the incision to be closed. 
     
     
         20 . The surgical instrument of  claim 16 , wherein the first and second jaws include a superior surface opposite the inferior surface, the first clamping surface and the second clamping surface forming an aperture therebetween when disposed adjacent one another, the aperture extending from the superior surface to the inferior surface. 
     
     
         21 . A surgical instrument for clamping a target structure, comprising:
 a clamp having a first jaw forming a first clamping surface, and a second jaw forming a second clamping surface that opposes the first clamping surface, the clamping surfaces including an inferior surface of the clamp cooperatively formed by the first and second jaws for resting on tissue to be clamped, the first and second jaws including a superior surface opposite the inferior surface, the first clamping surface and the second clamping surface forming an aperture therebetween when disposed adjacent one another, the aperture extending from the superior surface to the inferior surface;   a handle connecting the first and second jaws wherein the handle has a resilient bias that resiliently biases the first clamping surface and second clamping surface against each other into a substantially closed relationship for clamping the target structure;   wherein the handle is movable to overcome the resilient bias and open the clamp by moving at least one of the first jaw and the second jaw to an open position while maintaining the first clamping surface and the second clamping surface in a substantially aligned orientation relative to one another, the handle including an arm portion and a leg portion, wherein the arm portion comprises first and second arms that are respectively connected to the first jaw and the second jaw, and the leg portion comprises first and second legs that join at a common apex of the leg portion with a resilient bias that resiliently biases the first clamping surface and second clamping surface against each other into a substantially closed relationship for clamping the target structure.   
     
     
         22 . The surgical instrument of  claim 21 , wherein the aperture is substantially round. 
     
     
         23 . The surgical instrument of  claim 21 , wherein the first clamping surface includes a first clamping surface recess, and the second clamping surface includes a second clamping surface recess, the first and second clamping surface recesses forming the aperture when the first and second clamping surfaces are disposed adjacent one another. 
     
     
         24 . The surgical instrument of  claim 21 , wherein the clamp further comprises compression prongs that extend downwardly from the inferior surface of each jaw for extending toward an incision to be closed. 
     
     
         25 . The surgical instrument of  claim 21 , wherein the first and second legs are disposed in a plane that extends at an angle to the first and second jaws of the clamp. 
     
     
         26 . The surgical instrument of  claim 21 , wherein the first and second arms are substantially parallel.